1. Two More E’s and How to Spread On the CUSP: Stop BSI

2. 2 Learning Objectives To think ahead about ways to make your investment of time and improvements in BSI rates last forever To make sure all patients in your institution have access to the same level of safety in their care

3. 3 Implementation Framework

4. 4

5. 5 Why worry about the distant future? What you can anticipate: − Turnover of staff/new staff − New projects/distractions − Complacency − Emergencies and complex cases (someone will call for exceptions to be made) Endure—Plan for Sustainability

6. 6 Things you can do now to support long term viability of the BSI reduction − Write it into policy − Include in training for all new members − Audit or monitor to be sure it is routine practice − Set up reliable supply chain (borrowing protocol; alert system; assign someone) − Quarterly review by executive partner − Set up a Learning Network of peers − Have regular meetings with your infection preventionist Endure—Plan for Sustainability

7. 7 Practices that aided sustainability in the Michigan Project Including continued feedback of infection data that the team perceived as valid Improvements in safety culture that occurred as part of the overall Keystone ICU project An unremitting belief in the preventability of bloodstream infections Involvement of senior leaders who reviewed infection data and provided teams with the resources needed A shared goal rather than a competition to reduce infection rates throughout the state Endure—Plan for Sustainability Pronovost, PJ; Christine Goeschel et al. “Sustaining Reductions in Catheter-Related Bloodstream Infections in Michigan Intensive Care Units” British Medical Journal, February 4, 2010; 340:c309.

8. 8 Expand—Spread the Intervention Why think about expanding to other units? – Requires self study – Solidifies own understanding – Equal protection for all patients (lines are placed elsewhere) – Unique challenges of other units may offer new ideas and methods/may change your perceptions of your own implementation

9. 9 Expand—Spread to New Projects Why think about your next project? – Quality can always improve – Use new capacity to change to make care better – Maintain engagement of staff/interest and attention of management – Permits some control over what the next initiative will be – More rewarding environment

10. 10 Make the project an organizational goal or strategic initiative Identify the owner or executive who will be responsible for spread Identify the person or team to manage day-to-day spread activity Bundle changes (or interventions) in an easily adopted and tested package Develop a plan and targets for spread initiative Define specific goals of spread Define specific improvements that will be made Define timeframe of the spread effort Create template for feedback report to the sites for monitoring progress IHI’s A Framework for Spread Massoud MR, Nielsen GA, Nolan K, Schall MW, Sevin C. A Framework for Spread: From Local Improvements to System-Wide Change. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2006. (Available on www.IHI.org)www.IHI.org

11. 11 Action Items Start planning now for sustaining the intervention for years to come Work with your executive partner and unit heads to expand the intervention into other units Engage staff in thinking about the next mountain they would like to climb, while maintaining low BSI rates

12. 12 Reference List Buchanan D, Fitzgerald L, Ketley D, Gollop R, Jones JL, Saint Lamont S, Neath A and Whitby E. No going back: A review of the literature on sustaining organizational change. International Journal of Management Reviews 2005; 7(3):189-205. Evashwick C, Ory M. Organizational characteristics of successful innovative health care programs sustained over time. Fam Community Health. 2003 Jul-Sep;26(3):177-93. Greenhalgh T, Robert G, Macfarlane F, Bate P and Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004;82(4):581-629.